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Managing Motion from End to End

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Everything from SRS to SBRT with AlignRT.

A presentation from Gabor Menyhart, Chief Physicist at Cape Cod Healthcare, at ASTRO 2015.

Published in: Health & Medicine
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Managing Motion from End to End

  1. 1. Expert physicians. Quality hospitals. Superior care. Managing Motion from End to End Everything from SRS to SBRT with AlignRT Presented by Gabor Menyhart, Chief Physicist ASTRO 2015 ©2014 Cape Cod Healthcare Inc.
  2. 2. Expert physicians. Quality hospitals. Superior care. Outline • Equipment • QA • Breast etc. • DIBH (breast, lung, abdominal) • SBRT • SRS ©2014 Cape Cod Healthcare Inc. 2
  3. 3. Expert physicians. Quality hospitals. Superior care. AlignRT at Cape Cod Hospital • AlignRT with TrueBeam in 2011, MMI upgrade in 2015 • AlignRT/GateCT for CT simulations in 2011 • AlignRT for 2nd linac in 2012 • HD camera swap in 2014 for SRS procedures ©2014 Cape Cod Healthcare Inc. 3
  4. 4. Expert physicians. Quality hospitals. Superior care. High Resolution Camera ©2014 Cape Cod Healthcare Inc. 4
  5. 5. Expert physicians. Quality hospitals. Superior care. TrueBeam Treatment Room ©2014 Cape Cod Healthcare Inc. 5
  6. 6. Expert physicians. Quality hospitals. Superior care. 6EX Treatment Room ©2014 Cape Cod Healthcare Inc. 6
  7. 7. Expert physicians. Quality hospitals. Superior care. CT Simulator Room ©2014 Cape Cod Healthcare Inc. 7
  8. 8. Expert physicians. Quality hospitals. Superior care. Daily QA ©2014 Cape Cod Healthcare Inc. 8
  9. 9. Expert physicians. Quality hospitals. Superior care. Daily QA ©2014 Cape Cod Healthcare Inc. 9
  10. 10. Expert physicians. Quality hospitals. Superior care. Daily QA – TrueBeam Isocal on SBRT and SRS days ©2014 Cape Cod Healthcare Inc. 10
  11. 11. Expert physicians. Quality hospitals. Superior care. Daily QA – AlignRT IsoCal on SRS Days ©2014 Cape Cod Healthcare Inc. 11
  12. 12. Expert physicians. Quality hospitals. Superior care. Daily QA – Align RT IsoCal on SRS Days ©2014 Cape Cod Healthcare Inc. 12
  13. 13. Expert physicians. Quality hospitals. Superior care. Simulation/Treatment – Breast etc. ©2014 Cape Cod Healthcare Inc. 13 • Reconstructed DICOM surface available from scan • Use for setup and monitoring in treatment room • Capture reference image a the time of treatment if required
  14. 14. Expert physicians. Quality hospitals. Superior care. DIBH Simulation ©2014 Cape Cod Healthcare Inc. 14 • LT Breast and Chest Wall • Coach patient (scan vs beam on time) • Free breathe and breath hold scans captured • No need for camera unless breath hold is being monitored
  15. 15. Expert physicians. Quality hospitals. Superior care. DIBH Treatment ©2014 Cape Cod Healthcare Inc. 15 • Setup patient using free breathe DICOM surface • Switch to Breath Hold surface and verify breath hold • Use coaching screen if needed
  16. 16. Expert physicians. Quality hospitals. Superior care. 4D/SBRT Simulation • Immobilization devices (SBRT, vaclock bag, lung board only) • Patient coaching for 4D sim • Lighting conditions for proper surface capture, skin tone • Identify appropriate Tracking Patch • Determine breathing period • Determine if 4D is usable or DIBH is necessary • 4D QA using phantom monthly and annual end-to-end testing ©2014 Cape Cod Healthcare Inc. 16
  17. 17. Expert physicians. Quality hospitals. Superior care. 4D/SBRT Simulation ©2014 Cape Cod Healthcare Inc. 17
  18. 18. Expert physicians. Quality hospitals. Superior care. 4D/SBRT Simulation ©2014 Cape Cod Healthcare Inc. 18
  19. 19. Expert physicians. Quality hospitals. Superior care. 4D/SBRT Simulation ©2014 Cape Cod Healthcare Inc. 19
  20. 20. Expert physicians. Quality hospitals. Superior care. Free Breathe or DIBH • After 4D simulation tumor motion was determined to be more than 1cm • Attempted simulation with compression belt, but not enough surface information to reconstruct tumor motion • Capture free breathe and DIBH scan (possible to choose breath hold phase after 4D scan based on binning) ©2014 Cape Cod Healthcare Inc. 20
  21. 21. Expert physicians. Quality hospitals. Superior care. Treatment Planning • ITV is contoured on MIP (tumor volume is contoured on individual phases if attached to structure) • Normal structures contoured on average image set • VMAT, 6XFFF, 3 arcs • Planner transfers information to AlignRT workstation • Therapists import information and create ROI • Physicist reviews ROI before delivery ©2014 Cape Cod Healthcare Inc. 21
  22. 22. Expert physicians. Quality hospitals. Superior care. SBRT Plan ©2014 Cape Cod Healthcare Inc. 22
  23. 23. Expert physicians. Quality hospitals. Superior care. Free Breathe Treatment Delivery • DICOM surface for initial setup • CBCT • Acquire Gated Reference Surface after shifts • Monitor throughout treatment • Repeat CBCT if needed ©2014 Cape Cod Healthcare Inc. 23
  24. 24. Expert physicians. Quality hospitals. Superior care. DIBH Treatment Delivery • Setup patient using Free Breathe DICOM structure • Verify breath hold using DIBH DICOM • Perform CBCT with DIBH • After CBCT analysis, breath hold, shift, re-capture, breathe • Treat using the newly captured DIBH reference surface ©2014 Cape Cod Healthcare Inc. 24
  25. 25. Expert physicians. Quality hospitals. Superior care. SBRT Treatment ©2014 Cape Cod Healthcare Inc. 25
  26. 26. Expert physicians. Quality hospitals. Superior care. SRS Simulation ©2014 Cape Cod Healthcare Inc. 26
  27. 27. Expert physicians. Quality hospitals. Superior care. SRS SIMT Plan ©2014 Cape Cod Healthcare Inc. 27
  28. 28. Expert physicians. Quality hospitals. Superior care. SRS Treatment ©2014 Cape Cod Healthcare Inc. 28
  29. 29. Expert physicians. Quality hospitals. Superior care. SRS Treatment ©2014 Cape Cod Healthcare Inc. 29
  30. 30. Expert physicians. Quality hospitals. Superior care. SRS Treatment ©2014 Cape Cod Healthcare Inc. 30
  31. 31. Expert physicians. Quality hospitals. Superior care. SRS Treatment ©2014 Cape Cod Healthcare Inc. 31
  32. 32. Expert physicians. Quality hospitals. Superior care. Conclusion • AlignRT is a great solution to decrease setup and imaging times • Monitoring during treatment is very reassuring • Staff confidence develops rapidly • Use for setup and DIBH • Starting/expanding SBRT/SRS program follows ©2014 Cape Cod Healthcare Inc. 32
  33. 33. Expert physicians. Quality hospitals. Superior care. Thank you ©2014 Cape Cod Healthcare Inc. 33

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